Acute myeloid leukemia - Acute
Rahul Soman, M. Pharm
Definition
Clonal expansion and accumulation of greater than 20% leukemic myeloid blasts in the blood or bone marrow
Medical History
* History of Antineoplastic Agent use
* History of Alkylating Agent use
* History of Etoposide use
* History of Anthracycline use
* Past medical history of Radiation injury
* Myelodysplastic syndrome
* Solvents -toxic effects
* Smoking
Findings
* Infection of skin
* Myeloid sarcoma
* Asthenia
* Fatigue
* Fever
* Loss of appetite
* Pallor
* Gingival enlargement
* Bleeding
* Bleeding gums
* Easy bruising
* Epistaxis
* Petechiae
* Skin plaque
* Dyspnea - Acute
* Respiratory crackles
* Tachypnea
* Hepatosplenomegaly
* Splenomegaly
* Bone pain
* Painful swelling of joint
* Dysphagia
* Oral candidiasis
* CNS symptom
* Confusion
* Headache
* Lymphadenopathy - Acute
* Sensory disorder
* Blurred vision
* Optic disc edema
* Pallor of optic disc
Tests
Detection of meningeal disease, myeloid sarcomas, or CNS bleeding
* Magnetic resonance imaging, Brain and spinal cord structure
Determination of blast percentage and performance of primary morphologic analysis
* Peripheral blood smear examination, light microscopy
Suspected and known acute leukemia
* Bone marrow examination: Acute leukemia is defined as the presence of at least 20% blasts in the marrow or blood .
Suspected and known acute myeloid leukemia
* Chromosome analysis, cytogenetic procedure AND/OR molecular biology method, Bone marrow specimen: Treatment decisions and prognosis may rest on the cytogenetic or molecular genetic profile .
Suspected and known acute myeloid leukemia
* Complete blood count with white cell differential, manual: Neutropenia, thrombocytopenia, and/or anemia are common findings in acute myeloid leukemia (AML) ; a finding of 20% blasts indicates AML .
Acute leukemia
* White blood cell cytochemistry: A variety of cell markers may be used to identify and classify acute leukemias .
Evaluation of renal involvement
* Measurement of renal function
Suspected and known acute myeloid leukemia
* Flow cytometry, cell marker analysis: The presence of at least 2 myeloid-specific markers and no more than one lymphoid-specific marker is diagnostic for acute myeloid leukemia .
Suspected or known electrolyte imbalance in patients with malignancy
* Electrolytes measurement, serum: Serum electrolyte imbalance is common in malignancy-related disorders such as neutropenic sepsis, tumor lysis syndrome (TLS), and cancer-related metabolic disorders. .
Acute leukemia
* HLA antigen typing: Early HLA typing and donor search implementation is indicated for potential candidates for allogeneic hematopoietic stem cell transplantation .
Suspected and known disseminated intravascular coagulation (DIC)
* Disseminated intravascular coagulation screen: A panel of tests is more efficient and accurate than a single test in diagnosing disseminated intravascular coagulation (DIC) .
History of anthracycline treatment or cardiac dysfunction, and as baseline evaluation prior to anthracycline therapy
* Echocardiography
Differential Diagnosis
* Acute myeloid leukemia - Acute
* Acute myeloid leukemia with recurrent genetic abnormalities
* Acute promyelocytic leukemia, FAB M3
* Acute myeloid leukemia with multilineage dysplasia
* Therapy-related acute myeloid leukemia
* Central nervous system leukemia
* Myeloid sarcoma
* Chronic myeloid leukemia
* Acute lymphoid leukemia - Acute
* Myelodysplastic syndrome
* Hodgkin's disease - Chronic
* Non-Hodgkin's lymphoma - Chronic
* Multiple myeloma - Chronic
* Aplastic anemia - Acute
* Megaloblastic anemia due to vitamin B12 deficiency - Chronic
* Megaloblastic anemia due to folate deficiency - Chronic
* Epstein-Barr virus infection
* Infectious mononucleosis - Acute
* Erythroleukemia, FAB M6
Treatment
Drug Therapy
Standard induction therapy for adult patients under 60 years of age with de novo acute myeloid leukemia
CYTARABINE
Adults: Standard-dose cytarabine (100 mg/m2 by continuous infusion) for 7 days plus idarubicin OR daunorubicin OR mitoxantrone injections for 3 days, for 1 or 2 cycles
Primary induction therapy for patients with M3 morphology and confirmed t(15;17) cytogenetics
TRETINOIN
Procedural Therapy
Acute myeloid leukemia
* Hemopoietic stem cell transplant: Allogeneic hematopoietic stem cell transplant provides the best odds for long-term disease-free survival for patients with high-risk AML .
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